慢性肝病患者中小肠细菌过度生长的研究  

Study of intestinal bacterial overgrowth in patients with chronic liver disease

作　　者：黄梦雪 陈刚[1] 王鹏 曹世国 许建明[1] 梅俏[1] 洪汝涛[1] 张卫平[1] Huang Mengxue;Chen Gang;Wang Peng;Cao Shiguo;Xu Jianming;Mei Qiao;Hong Rutao;Zhang Weiping(Dept of Gastroenterology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Basic Medical College,Anhui Medical University,Hefei 230032)

机构地区：[1]安徽医科大学第一附属医院消化内科,合肥230022 [2]安徽医科大学基础医学院,合肥230032

出　　处：《安徽医科大学学报》2022年第7期1134-1137,共4页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81700521)。

摘　　要：目的利用乳果糖氢呼气试验(LHBT)检测肝硬化和慢性肝炎肝纤维化(CHF)患者中小肠细菌过度生长(SIBO)的发生率,探讨其与炎症因子及氧化应激相关指标的关系。方法选取38例CHF患者和60例肝硬化患者以及31例健康对照组,利用LHBT的方法评估各组SIBO发生率。然后将受试者分为SIBO阳性组和SIBO阴性组,比较两组间临床症状和实验室检查,并检测其血清脂多糖(LPS)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、IL-10水平以及二胺氧化酶(DAO)、超氧化物岐化酶(SOD)、谷胱甘肽(GSH)、过氧化氢酶(CAT)水平,并对所检测的LPS、IL-6、TNF-α、IL-10、DAO、SOD、GSH、CAT的浓度与LHBT集值的相关性进行统计学分析。结果①CHF组和肝硬化组以及对照组SIBO阳性率分别为36.84%、60.00%和9.68%,差异有统计学意义(P<0.01);②SIBO阳性组患者和阴性组患者在Child–Pugh(CTP)分级及腹水的表现上差异有统计学意义(P<0.05);③SIBO阳性患者血清中LPS、IL-6、DAO、CAT、SOD水平高于SIBO阴性患者(P<0.05),IL-10、TNF-α以及GSH水平与SIBO阴性组差异无统计学意义;④患者LHBT集值与LPS、IL-6、DAO、SOD、CAT呈正相关(P<0.05),与TNF-α、IL-10、GSH的相关性差异无统计学意义。结论CHF以及肝硬化患者较健康对照组更易发生SIBO,且与外周血中多种炎症因子和氧化应激指标水平升高相关。SIBO可能通过肠道菌群失调导致的炎症反应和氧化应激等途径加重CHF和肝硬化患者的病情变化。Objective To detect the difference in the incidence of small intestinal bacterial overgrowth(SIBO)in patients with liver cirrhosis and chronic hepatitis fibrosis(CHF)with the lactulose hydrogen breath test(LHBT),and to explore the relationship between SIBO and inflammatory factors and oxidative stress related indicators.Methods LHBT was performed on 38 CHF patients,60 cirrhosis patients and 31 healthy controls to evaluate the incidence of SIBO.The patients were further divided into SIBO-positive and negative group.Then we compared related clinical symptoms and laboratory tests between the two groups and detected lipopolysaccharide(LPS),interleukin(IL)-6,tumor necrosis factor(TNF)-α,IL-10 level,and several kinds of oxidative stress indicators such as diamine oxidase(DAO),superoxide dismutase(SOD),glutathione(GSH),catalase(CAT).Statistical analysis was conducted to analyze the correlation between the concentration of LPS,IL-6,TNF-α,DAO,SOD,GSH,CAT and LHBT summation value.Results①The positive rate of SIBO in CHF group,cirrhosis group and control group was 36.84%,60.00%and 9.68%,respectively.The difference was statistically significant(P<0.01).②The differences in CTP classification and ascites were statistically significant between the two subgroups with and without SIBO(P<0.05).③The levels of LPS,IL-6,CAT,DAO and SOD in SIBO-positive group were higher than those in negative group(P<0.05).However,the concentrations of IL-10,TNF-αand GSH were similar between the two groups.④The LHBT summation value was positively correlated with the concentrations of LPS,IL-6,DAO,SOD and CAT in serum(P<0.05),but had no significant correlation with TNF-α,IL-10 and GSH.Conclusion Compared with healthy controls,CHF and cirrhosis patients are more likely to develop SIBO.It is also related to the increase of inflammatory factors and oxidative stress indexes in peripheral blood.SIBO may aggravate the inflammatory response of CHF and cirrhosis patients through intestinal flora dysregulation and oxidative stress,thus aggravating

关 键 词：肝硬化 小肠细菌过生长 呼气试验 氧化应激 肠道菌群 

分 类 号：R575.2[医药卫生—消化系统] R[医药卫生—内科学]